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TFOS DEWS III: Digest.

Fiona Stapleton1, Pablo Argüeso2, Penny Asbell3

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|June 5, 2025
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Summary
This summary is machine-generated.

Recent dry eye disease (DED) research highlights sex and gender differences, new risk factors, and clarified pathophysiology. Advancements in tear film analysis and clinical trial design offer improved DED diagnosis and management strategies.

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Area of Science:

  • Ophthalmology
  • Dry Eye Disease Research
  • Ocular Surface Science

Background:

  • The 2017 TFOS DEWS II reports established a baseline for dry eye disease (DED) research.
  • Interdisciplinary research since 2017 has expanded understanding of DED's complexities.
  • Key areas include sex/gender influences, epidemiology, pathophysiology, tear film, pain, iatrogenic factors, and clinical trial design.

Purpose of the Study:

  • To summarize and synthesize recent interdisciplinary research in dry eye disease (DED) published after the 2017 TFOS DEWS II reports.
  • To explore how advancements in various research areas inform DED diagnosis, subtype classification, and management.
  • To identify emerging trends and future directions in DED research and clinical practice.

Main Methods:

  • Comprehensive review and synthesis of interdisciplinary research on dry eye disease (DED).
  • Analysis of studies published since the 2017 TFOS DEWS II reports, covering seven key topics.
  • Integration of findings related to sex, gender, hormones, epidemiology, pathophysiology, tear film, pain, iatrogenic DED, and clinical trial design.

Main Results:

  • Sex and gender significantly impact DED due to hormonal, genetic, epigenetic, and behavioral factors.
  • Prevalence of DED varies by age and sex, with new risk factors including environmental, iatrogenic, systemic, and lifestyle elements.
  • Pathophysiology distinctions between aqueous-deficient and evaporative DED are clearer, with evaporative DED often involving muted inflammation and meibomian gland dysfunction.
  • Tear film research reveals potential biomarkers like microRNAs.
  • Ocular pain perception is linked to corneal nerve integrity and nervous system activity.
  • Iatrogenic DED arises from medications, contact lenses, and surgery.
  • Clinical trials are increasingly focused on aligning design with DED subtypes and therapeutic mechanisms.

Conclusions:

  • Sex and gender differences are crucial considerations in understanding and managing DED.
  • Emerging research provides deeper insights into DED pathogenesis, risk factors, and diagnostic approaches.
  • Advancements in understanding tear film, pain mechanisms, and iatrogenic causes necessitate refined clinical trial designs and therapeutic strategies for effective DED management.